Method for sterilizing and closing accessory canals of a tooth

ABSTRACT

A dental laser assembly is disclosed for use in eradicating carious lesions in teeth, the treatment of sensitive teeth, as well as the removal of soft tissue, the incising of the frenum, opurculum, anesthesia of the tooth, etching enamel for restorations or orthodontic appliance fixation, the welding of fixed prosthesis, removal of bacterial flora periodontal pockets, removal and/or vaporization of healthy or necrotic pulp, the vertical and/or horizontal condensation of gutta percha or any other root canal sealant, the cauterization of blood vessels in the oral cavity, vaporizing bone tissue, removing tartar, apical fusion of foramina, enlarging and shaping root canal, removing carbon from surface of teeth, removal of enamel, bleaching teeth, etching dentin, separating orthodontic brackets, merging hydroxyapatite to bone and enamel, amalgam removal and undercutting of carious and/or healthy dentin and/or cementum. The laser assembly includes a housing having a cavity in which a pulsed laser is contained. The laser is excited so that the laser emits a laser beam along a predetermined axis that is in line with a fiber optic delivery system and at a pulse rate of one to 10,000 pulses per second and an average power variable from one tenth to 50 watts. A handpiece is dimensioned to be inserted into a human mouth while an optical fiber optically connects the laser output to the handpiece. The laser assembly also includes a continuous output aiming laser which, upon activation, provides a continuous laser aiming beam coaxial to the treatment beam. Both beams are then introduced into a fiber optic delivery system.

This is a divisional of copending application Ser. No. 07/707,163, filedon May 28, 1991, pending, which is a divisional application of Ser. No.07/493,965, filed Mar. 15, 1990, now U.S. Pat. No. 5,055,048, which is acontinuation-in-part patent application of Ser. No. 07/342,190, filedApr. 24, 1989, now U.S. Pat. No. 4,940,411, which is acontinuation-in-part of Ser. No. 07/236,450, filed Aug. 25, 1988,abandoned.

BACKGROUND OF THE INVENTION

I. Field of the Invention

The present invention relates generally to laser assemblies and, moreparticularly, to a laser assembly particularly suited for dentalapplications such as the eradication of carious lesions, the treatmentof sensitive teeth, and the removal of soft tissue.

II. Description of the Prior Art

There have been a number of previously known Neodymium doped YttriumAluminum Garnet (Nd:YAG) laser systems that have been used for medicalsurgical applications. These previously known laser systems typicallyhave been constructed to provide very high average powers, i.e. in therange of 60 to 100 watts of continuous power. Consequently, thesepreviously known systems have required high power electrical supplysystems, typically 220 volts.

There have been a number of disadvantages to these previously knownNd:YAG systems. One disadvantage is that these systems are heavy anddifficult to move and also require substantial cooling systems in orderto cool the laser head and the power supply. Furthermore, since suchsystems are typically powered by 220 volt line current, it has beennecessary to install separate electrical receptacles for thesepreviously known systems.

These previously known systems oftentimes use fiber optic deliveryhaving a simple focusing lens at the output from the fiber optic. Insome systems, contact tips were used to deliver the laser power to thetarget site. These previously known delivery systems, however, had beensomewhat bulky and difficult to use.

To date, there has never been a Nd:YAG laser system particularly suitedfor dental laser applications. Such applications include the eradicationof carious lesions, the treatment of sensitive teeth, as well as theremoval of soft tissue.

U.S. Pat. No. 4,818,230 to Myers et al. is commonly owned with thispatent and discloses a method for removing decay from teeth. In theMyers' patent, the power levels of the laser was limited to 100millijoules per pulse for fear of causing pain for the patient byheating the tooth. New research and new applications, however, have madeit necessary to consider higher powers and pulse repetition rates.

SUMMARY OF THE PRESENT INVENTION

The present invention provides a dental laser assembly which overcomesall of the above mentioned disadvantages of the previously knowndevices.

In brief, the dental laser assembly of the present invention comprises ahousing having a cavity in which a pulsed Nd:YAG laser is contained. Anexciting flash lamp is also contained within the cavity and, uponexcitation, causes the laser to emit a pulsed laser beam along apredetermined axis. Preferably, the repetition rate for the laser isapproximately one to 10,000 pulses per second and a duration at eachpulse between several picoseconds and several milliseconds. The averagepower of the laser is between one tenth and 50 watts and is adjustable.

An optical fiber is connected through a coupling to the housing so thatthe axis of the optical fiber is coincidental with the axis of the laserbeam output. The other end of the fiber optic is connected to anelongated handpiece. This handpiece preferably includes either a mirrorassembly or an arcuate fiber optic segment or ceramic tip so that thehandpiece directs the laser beam in a direction substantiallyperpendicular to the axis of the handpiece. This allows the handpiece tobe inserted and manipulated into the mouth of the patient and used inthe fashion of a conventional dentist drill.

In addition, the laser assembly of the present invention comprises acontinuous wave, low powered visible laser having its output coaxialwith the output from the pulsed laser. The continuous wave laser ispreferably a helium-neon (HeNe) laser so that its output is in thevisible range of the human eye. The continuous wave laser thus providesan aiming beam for the laser since the output from the Nd:YAG laser isinvisible.

In operation, upon excitation of the pulsed laser, the pulse lasergenerates an output capable of removing carious lesions, the treatmentof sensitive teeth, as well as removing soft tissue. Furthermore, theoptical segment on the handpiece is preferably removable for cleaningand sterilization and replaceable with different optical segments fordifferent dental applications.

It has also been found that, by using relatively low laser powers, i.e.30-300 millijoules per pulse, and lasing healthy dentin and/or enamel,desensitation of the tooth is achieved. It has been found that byirradiating surface areas of the tooth, analgesia can be applied to thetooth thereby causing the anesthesia effect upon the tooth. This in turnpermits higher energy levels per pulse to be utilized without causingpatient discomfort which, in turn, allows the dental procedure to bequickly accomplished.

BRIEF DESCRIPTION OF THE DRAWING

A better understanding of the present invention will be had uponreference to the following detailed description when read in conjunctionwith the accompanying drawing, wherein like reference characters referto like parts throughout the several views, and in which:

FIG. 1 is a view illustrating the main unit of a preferred embodiment ofthe laser assembly of the present invention:

FIG. 2 is a view illustrating the delivery system for the preferredembodiment of the invention:

FIG. 3 is a diagrammatic view illustrating the preferred embodiment ofthe present invention:

FIG. 4 is a side sectional view illustrating a preferred handpiece ofthe present invention:

FIG. 5 is a fragmentary sectional view similar to FIG. 4 butillustrating a different tip;

FIG. 6 is a view similar to FIG. 4 but illustrating still anotherfurther modification thereof;

FIG. 7 is a sectional view of an alternative embodiment of the cable andhandpiece;

FIG. 8 is a fragmentary sectional view similar to FIG. 6 showing afurther alternative embodiment of the tip;

FIG. 9 is a crossectional view of a tooth; and

FIG. 10 is a crossectional view illustrating an endontic procedure.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS OF THE PRESENT INVENTION

With reference first to FIGS. 1 and 2, a preferred embodiment of thedental laser assembly 10 of the present invention is thereshown andcomprises a main unit 12 and the fiber optic laser beam delivery system14. The main unit 12 preferably includes rollers 16 at one end formobility so that the main unit 12 can be moved as desired. The other endof the main unit rests on posts 17. The unit is lifted with aretractable handle 19 so as to be moved on the rollers 16.

Still referring to FIGS. 1 and 2, the main unit 12 includes a fiberoptic output connector 26 along one side. A control panel 20 is providedat the top of the main unit 12 to control the activation and use of thedental laser system 10.

Referring still to FIGS. 1 and 2, the fiber optic cable assemblycomprises an elongated fiber optic 22 which is flexible. One end 24 ofthe fiber optic 22 is received within the fiber optic connector 26. Alock nut 28 adjacent the end 24 of the fiber optic 22 locks to theconnector 18 in order to secure the fiber optic 22 to the main unit 12for a reason to be subsequently described.

Referring now particularly to FIG. 2, a handpiece 30 is provided at theopposite end 75 of the fiber optic cable 22. As will be subsequentlydescribed in greater detail, the fiber optic cable 22 delivers a laserbeam from the end 24 to the handpiece 30.

With reference particularly to FIG. 3, an Nd:YAG laser 32 is containedwithin a cavity 34 in the main unit 12. The YAG laser 32 is positionedwithin the cavity 34 so that the laser 32 generates a laser output beamalong a predetermined axis 36. Any conventional means, such as a flashlamp 38, is also contained within the cavity 34 to excite the laser 32so that the laser 32 generates a pulsed output.

The YAG laser has a pulse repetition rate of between one and 10,000pulses/sec., an average power of up to 50 watts and preferably betweenone tenth and fifty watts, a pulse duration of between a picosecond andseveral milliseconds and a peak energy of up to five joules/pulse. Thepeak power will vary depending upon the pulse duration and pulse energyand, similarly, the average power will vary depending upon the energy ofeach pulse, and the repetition rate. However, since the output power ofthe laser is less than 50 watts, the laser can be operated from astandard 110 volt electrical power supply and without the necessity ofan external cooling system to cool the laser cavity 34.

Conventional electronics operated through the control panel 20 enablethe average power, pulse energy, and pulse repetition rate to be userselected. These factors will vary in dependence upon the dentalprocedure involved as subsequently discussed.

Still referring to FIG. 3, a reflecting mirror 40 is positioned adjacentto one end of the laser 32 while a semi-reflective mirror 42 ispositioned adjacent the other end of the laser 32. The mirrors 40 and 42thus cause the laser 32 to generate an output along the axis 46, througha fiber focus lens 48 and into one end 50 of the fiber optic 22. Thefiber optic 22 then carries or delivers the laser output from the laser32 to the handpiece 30 which will be subsequently described in greaterdetail.

A shutter solenoid 54 is also preferably contained within the mainhousing 12 and operates a movable shutter 56 (illustrated onlydiagrammatically). With the shutter 56 in its upper or retractedposition, illustrated in solid line, the laser beam from the laser 32passes through the lens 48 and out through the fiber optic 22.Conversely, with the shutter 56 in its extended position, illustrated inphantom line, the shutter 56 blocks the output from the laser 32 toprevent unintended laser outputs from the handpiece 30.

Still referring to FIG. 3, the main unit 12 also includes a continuouswave laser 60, such as a helium-neon (HeNe) laser. Such a laser providesa very low power output but, unlike the Nd:YAG laser 32, the output fromthe helium-neon laser 60 is in the visible range.

The output 62 from the HeNe laser 60 is reflected by prisms 64 and 66through the mirror 40 so that the HeNe laser output 62 is coaxial withthe axis 36 and thus with the laser outputs from the Nd:YAG laser 32.Thus, both the laser output from the continuous laser 60 as well as thepulse laser 32 are delivered through the fiber optic cable 22 to thehandpiece 30. The continuous laser output 62 provides an aiming outputsince the output from the pulse laser 32 is invisible.

Other means for aiming the pulsed laser can, of course, be alternativelyused.

The main housing further includes a cooling system 110 for cooling thepulsed laser 32. The cooling system can be of any conventionalconstruction, for example, having a coolant of 50% ethylene glycol and50% deionized water. This coolant is pumped by a pump while a flowmeter112 monitors the flow of the coolant. The fluid is pumped through thelaser cavity and through a radiator and then circulated. In the eventthat the flow of the coolant is interrupted, the laser 32 is deactivatedin order to prevent the laser 32 from overheating.

Alternatively, the cooling system 110 is housed separately from the mainhousing. Such an arrangement is advantageous in that it (1) minimizesthe size of the housing and (2) allows the cooling system 110 to becombined with the cooling systems for other equipment used by thedentist.

With reference now particularly to FIG. 4, one preferred embodiment ofthe handpiece 30 is thereshown and comprises an elongated body 70 havinga first end 72 and a second end. The fiber optic cable 22 extendsthrough the handpiece body 70 from the end 72 and terminates at a point76 short of the handpiece end. The output from the end 75 of the fiberoptic is concentrated by a collimating lens 78 to a mirror 80. Themirror 80 reflects the laser output substantially at a right angle tothe axis of the handpiece body 70, through a lens 81 and a protectivewindow 82 and so that the laser output focuses at a point 84 adjacent tothe output window 82 of the handpiece body 70.

Preferably, the handpiece 30 is of substantially the same shape and sizeas a conventional dentist drill. As such, the handpiece body 70 can beeasily manipulated in the mouth of the patient in the same fashion as adental drill.

In operation, upon activation of both lasers 60 and 32, both thecontinuous wave from the laser 60 as well as the pulsed output from thelaser 32 are delivered through the fiber optic 22, through thecollimating lens 78 (FIG. 4), mirror 80, focusing lens 81 and window 82so that both lasers focus at the point 84. Since only the output fromthe continuous wave laser 60 is in the visible range, the laser beamscan be easily focused since the size of the visible laser 60 is smallestat the point 84. When the laser is properly focused, activation of thepulse laser 32 removes the carious lesions, or the soft tissue as thecase may be. Furthermore, the laser beam simultaneously sterilizes thework area during use which is particularly advantageous for the removalof soft tissue and dental decay.

The actual power and energy levels used by the operator or dentist willvary depending upon the desired dental procedure. It has been found, forexample, that lasing the enamel of a healthy tooth with relatively lowenergy levels, e.g. less than 100 millijoules per pulse, desensitizesthe tooth by temporarily sealing or otherwise deactivating the dentinaltubules which normally carry the pain signals of the tooth.

With the tooth desensitized, higher energy levels, i.e. energy levelsbetween 100 millijoules and five joules per pulse, can be used withoutcausing patient discomfort. Since higher energy levels per laser pulseeradicate more dental decay, disease, soft tissue and the like per pulsethan laser pulses of lower energy, i.e. less than 100 millijoules/pulse,the overall dental procedure can be accomplished more quickly. This, inturn, saves "chair time" for the dentist and also is psychologicallyless stressful and less painful for the patient.

It has also been found that both temporary and permanent desensitizationof the tooth can be more rapidly and effectively achieved by coating thetooth with a pigmented material prior to lasing. Darker materials, suchas organic inks, have proven most effective for a Nd:YAG laser. However,different lasers are expected to react differently depending upon theoptical characteristics of the laser.

The average power required for soft tissue procedures is higher than fortooth procedures, and requires higher pulse repetition rates.Accordingly, a variable pulse repetition rate is provided to provide asmoother output and a higher average power.

In most cases the laser achieves sterilization through eradication ofbacteria. Complete sterilization, however, is not possible in all cases.Even in these cases where complete sterilization is not possible,reduction of bacteria and partial sterilization is almost alwaysachieved.

It has also been found in laboratory experiments that bacteria are"scattered" during high laser repetition rates of the laser, i.e.repetition rates in excess of about 30 laser pulses/second. Furthermore,efficient removal of bacteria without bacteria scattering is achievedwithin a range of 15-25 laser pulses/second. It has been found thatbelow 15 pulses/second eliminates scattering but unduly prolongs thesterilization process while some scattering occurs above 25pulses/second and unacceptable scattering occurs above 30 pulses/second.A slower pulse rate would be available for use with the holmium YAGlaser because it functions more at a surface level.

A pigment can also be sprayed on the tooth prior to lasing. This pigmentspray enhances light absorption by the tooth.

It has also been found that lasing teeth may carbonize the outer layerof the tooth. Removal of this carbon can be easily achieved by treatingthe carbonized portion of the tooth with an oxihalogen, preferably ahypo chlorite such as diluted sodium hypo chlorite or other hypochlorites or chlorides or using water, and then lasing the tooth.

External cooling of the tooth may also be necessary at high averagepower levels as well as at high energy/pulse levels and under mostcircumstances with the holmium YAG laser. Such tooth cooling can beaccomplished in any conventional fashion, such as by spraying water onthe tooth from a source 300 (FIG. 3). Since certain types of laseremissions are absorbed by water, a drying means 302, such as an airsprayer, is activated after each water spray but prior to a subsequentactivation of the pulsed laser.

It has also been found that high energy levels, i.e. energy levelsbetween 100 millijoules/pulse and five joules/pulse, are useful forendontic procedures such as root canals, apicoectomies and pulpectomieson a tooth 200 shown in FIGS. 9 and 10. The tooth 200 has an enamelouter shell 202, dentin 204 and a pulp chamber 206. In such endonticprocedures, the pulp chamber is opened at 210 (FIG. 10) and a laser tip212 is inserted. Activation of the laser at high power and/or energylevels eradicates the soft tissue in the pulp chamber 206 as desired.Simultaneously, the laser sterilizes the pulp chamber 206 and preventsinfection. Due to this sterilization, a partial pulpectomy, previouslyunknown, is possible without risk of infection of the pulp chamber.Furthermore, application of a pigmented material in the pulp chamberprior to lasing enhances the absorption of the laser emission along theroot canal chamber. This enhanced absorption fuses the dentin andcreates a smooth surface around the root canal which inhibits bacterialgrowth in the root canal chamber and accessory canals which typicallyare a host site for bacteria. As before, organic inks have proven mosteffective for this purpose.

The pigmented material, if desired, can be applied with a nozzle ormanually.

It is well known that, in many cases, the tooth discolors following rootcanal surgery. Hydrogen peroxide has been previously used to bleach orwhiten the discolored tooth. Lasing the tooth during application of thehydrogen peroxide causes the tooth bleaching to occur more rapidly andmore completely. Additionally, suspension of the hydrogen peroxide in agel or paste as it is applied to the tooth advantageously prevents thehydrogen peroxide from contacting and irritating the gum area.

These relatively high power and/or energy levels have also proven usefulfor performing curetage. Tumors and other growths can also be excisedusing such high powers.

Still other dental procedures are capable with the laser of the presentinvention. For example, it has been found that the laser of the presentinvention is advantageous for removing tartar buildup on the teeth. Insuch an application, the laser is focused at the tartar and repeatedlyactivated until the tartar is removed.

The preferred embodiment of the laser of the present invention has alsoproven useful for apical fusion of foramina. In such an application, thelaser is focused at the tooth area surrounding the foramina andrepeatedly activated until the area surrounding the foramina melts andfuses the foramina shut. This tooth material surrounding the foraminatypically comprises healthy dentin.

The laser can also be used for shaping the canal during an endontic orroot canal procedure. In such a procedure, the laser is aimed at thegood or undiseased dentin surrounding the nerve canal in the tooth. Thelaser is then repeatedly activated thereby eradicating the dentin andshaping or enlarging the root canal as well as sterilizing the rootcanal.

The laser of the present invention can also be used to heat gutta perchain the cavity left by the removal of a carious lesion. This renders thegutta percha more fluid so that it flows deeper into crevices of thecavity and creates a better bond between the gutta percha and thecavity.

The laser of the present invention has also been used for the bloodlessremoval of soft tissue. In such an application, the laser is aimed atthe soft tissue which is to be removed and repeatedly activated. Duringsuch a procedure, the laser beam simultaneously cuts the soft tissue andseals the blood vessels at the wound site as well as sterilizing thewound site. This in turn produces essentially a bloodless removal of thesoft tissue.

The laser of the present invention can also be used for anesthetizing atooth prior to preparation of the tooth with conventional instrumentsfor removal of decay and/or propon material restoration. In such aprocedure, the entire crown and/or root of the tooth is lased on allsurfaces including, but not limited to, the buccal, lingual, andocclusal surfaces thereby anesthetizing the entire target tooth.Although the precise procedure in which laser analgesia of the tooth andnerve endings is unknown, it is believed that the laser beam acts totemporarily close the tubuals and depolarize the nerve cells of theodontablast layer of the pulp for a time period sufficient to permit thedental procedure to be performed. In either event, the laser penetratesthe enamel, which may range up to 2 mm thick, in order to anesthetizethe tooth temporarily.

The laser of the present invention can also be used for removing toothenamel. Such removal is oftentimes necessary in order to eradicatediseased dentin behind the enamel. A holmium doped YAG laser has provenespecially effective for the removal of enamel. An erbium doped YAGlaser has also proven effective for enamel removal although, at present,erbium YAG lasers are more destructive to optical fibers of the typeused in a dental delivery system than a holmium YAG laser. Furthermore,it has been found that cooling the tooth during enamel removal enablesfaster removal of the enamel without damaging the tooth. Such coolingcan be accomplished by spraying a fluid, such as air or water, on thetooth during the enamel removal.

The laser can also be used for the intraoral welding of dentalappliances, such as braces and bridges, in the mouth. Synthetichydroxapatite can also be welded to the teeth to replace fillings by thelaser.

The laser can be used to incise the upper or lower frenum both labial orlingual. The advantage is that with the laser this procedure may not benecessary and bleeding probably will not occur. A lower frenectomy istypically performed to cure a malady called "tongue tied".

The laser can also be used to remove amalgam.

The laser of this invention can also be used to etch the enamel prior torestoration with various types of composites. Under current therapy itis necessary prior to installing the restoration to seal the dentin witha material such as calcium hydroxide which acts as a thermal liner,rinse, dry, etch the enamel with phosphoric acid or a like agent, rinse,dry then restore. A substantial time and material benefit is realizedwith the laser in that all the above steps in a tooth restoration areunnecessary. The laser is passed over the intended etch surface of theenamel during the removal of decay or just prior to installation of thesealing or bonding material. These procedures are completed withoutanesthesia in most cases thereby creating a significant cost savings tothe patient and/or doctor. The same procedure is used to etch enamelprior to bonding for brackets that fix to braces.

In the above discussed dental procedures, the laser has an energy outputof between 0.1 millijoules per pulse and 5 joules per pulse, an averagepower of less than 50 watts and a pulse repetition rate of up to 10,000pulses per second.

With reference now to FIG. 5, a modification of the handpiece isthereshown in which the end 74' of the handpiece body 30' includes aninternally threaded bore 90. This bore 90 detachably receives anexternally threaded tip 92. The tip 92 includes an elongated throughbore94 in which an arcuate fiber optic segment 96 is contained. The fiberoptic segment 96 is arranged in the tip 92 so that one end 98 is alignedwith the end 75 of the fiber optic 22 so that the laser output from thefiber optic 22 passes through the fiber optic 96 to its external end100. The external end 100 of the fiber optic segment 96 is preferably acontact point so that the laser ouput is focused at the end 100 of thefiber optic segment 92. Also, as shown in FIG. 5, the fiber opticsegment 96 is preferably arcuate so that the contact end 100 issubstantially at a right angle from the axis of the handpiece body 30'.

With reference now to FIG. 6, a modification of the tip 92 is thereshownin which the throughbore 94' is linear rather than arcuate as shown inFIG. 5. Consequently, the contact end 100' of the fiber optic segment96' is aligned with the axis of the handpiece body 30'. In all otherrespects, however, the tip 92' shown in FIG. 6 is the same as the tip 92shown in FIG. 5 and, for that reason, will not be again described.

With reference to FIG. 7, another embodiment of delivery system isshown. This comprises a single fiber 2 throughout and from input tooutput ends. A simple handpiece 98 is used to hold the fiber for use inthe mouth.

With reference to FIG. 8, another embodiment of a tin 101 is shown thatis designed to fit on the body 30'. The tip 101 is made of a ceramicmaterial that acts as a thermal insulator. A metal heating tip 102 ismounted in the tip 101 to extend from the distal end of the cable 22.The laser beam is delivered to the heating tip by the cable 22 to exitthe distal end of the cable to strike the heating tip 102. The heatingtip is made of a suitable material such as stainless steel which may beheated quickly to a high temperature and then used to cut and cauterizesoft tissue in the mouth.

Other configurations of tips 92 which are interchangeable with the tips92 or 92' shown in FIGS. 5 and 6 are also possible.

From the foregoing, it can be seen that the present invention provides asimple and yet highly effective dental laser system for removing cariouslessons, enamel and soft tissue as well as sterilization and otherdental procedures. The laser can also be used in endodontic applicationsfor eradicating diseased nerve tissue as well as sterilization the rootcanal. There are many advantages to the dental laser system of thepresent invention.

First, the dental laser system of the present invention is not onlyportable but it can also be operated from standard line current of 110volts. As such, special electrical wiring is not required in order toutilize the dental laser system of the present invention.

A still further advantage of the dental laser system of the presentinvention is that the delivery system utilizes a handpiece dimensionedto simulate the conventional dental handpiece used by dentists. As such,the handpiece of the present invention can be easily maneuvered in thepatient's mouth. Furthermore, the replaceable tips for the handpiecefurther enhance the flexibility of the operation and use of the dentallaser of the present invention.

Having described our invention, many modifications thereto will becomeapparent to those skilled in the art to which it pertains withoutdeviating from the spirit of the invention as defined by the scope ofthe appended claims.

We claim:
 1. A method for sterilizing or reducing bacteria in accessorycanals and closing the same in a tooth in a mouth, comprising the stepsof:aiming a pulsed laser so that the output from the laser impinges uponthe accessory canals in a tooth so that sterilization or reduction inbacteria takes place, aiming a pulsed laser so that the output from thelaser impinges upon the necessary canals thereby closing said canals sothat additional bacteria cannot enter or escape, wherein said laser hasan energy output per pulse sufficient to cause sterilization or reducebacteria in said accessory canals and closing the same, wherein saidlaser has an energy output per pulse sufficient to cause hemostasis,wherein said laser has an energy output of between 0.1 millijoules perpulse and 5 joules per pulse.
 2. The invention as defined in claim 1wherein the average power of said laser is between one tenth and fiftywatts.
 3. The invention as defined in claim 1 wherein the laser has apulse repetition rate of between one and 10,000 pulses per second. 4.The invention as defined in claim 1 wherein said pulsed laser is aNd:YAG laser.
 5. The invention as defined in claim 1 wherein said laseris a Holmium doped laser.
 6. The invention as defined in claim 1 whereinsaid laser is an Erbium doped laser.